The subhead is this: "Hospitals and doctors may be put on budget."
This change, which was recommended by a commission of stakeholders
including doctors and hospitals, is exactly the type of "delivery"
reform that health economists are always touting. In essence, every
insured person would receive an adjusted share of a predetermined
amount of money that insurers and government programs will use to pay
for their health expenses for a year. As the Boston Globe notes,
"[p]roviders
would have to work within a predetermined budget, forcing them to
better coordinate patients' care, which could improve quality and
reduce costs." There are many details to work out, and the devil
lurks: the "shares" must be adjusted for socioeconomic status,
different types of treatments, chronic conditions and other factors.
Doctors can't see their income disappear or dry up suddenly, or else
the reforms would be untenable. The public can't perceive the new
scheme as a form of rationing, although health care reform is
inevitably a form of rationing. Under the state's universal health
insurance scheme, which looks a bit like what Democrats are proposing
for the country, everyone (sans certain categories of non-citizen
immigrants) is required to hold or purchase health insurance, either
through their employer or through a "connecter"-like exchange system. Costs have increased fairly dramatically, as was predicted. By shifting to a system where outcomes determine payment more than services rendered, it might be possible to contain costs -- or at least to manage their growth.